Coeliac Disease

Question 1

What is the prevalence of coeliac disease?

Answer 1

Affects up to 1% of the population

Can present at any age

Question 2

What is interesting about the presentation of Coeliac disease?

Answer 2

So varied:

Diarrhoea
Failure to thrive
Iron deficiency anaemia
Osteoporosis

Question 3

How is Coeliac disease diagnosed?

Answer 3

Postive immunoglobulin A tissue transglutaminase serology

Confirmed by duodenal biopsy and histology

Question 4

What is the therapy for coeliac disease?

Answer 4

Strict, lifelong GF diet

Question 5

What are the complications of untreated coeliac disease?

Answer 5

GI symptoms
Malabsorption
Increased risk of mailgnancy
High overall mortality

Question 6

Define coeliac disease

Answer 6

Coeliac disease is a systemic autoimmune disease triggered by dietary gluten peptides

Question 7

What food is gluten found in?

Answer 7

Wheat
Rye
Barley
Related grains

Question 8

What does the immune activation of the small intestine lead to?

Answer 8

Villous atrophy
Hypertrophy of intestinal crypts
Increased lymphocytes in epithelium and lamina propia

Question 9

What are the common diagnostic factors?

Answer 9

IgA deficency
Diarrhoea
Bloating
Abdo pain/discomfort
Anaemia

FH
Osteopenia/porosis
Fatigue
Weight loss
Failure to thirve

Question 10

What are some uncommon diagnostic factors of Coeliac disease?

Answer 10

Dermatitis herpetiformis
Type 1 diabetes
Autoimmune thyroid disease
Apthous stomatitis
Dental enamel hypoplasia
Easy bruising
Peripheral neuropathy
Ataxia
Unexplained elevation of serum aminotransferase levels

Question 11

What are some strong risk factors for Coeliac?

Answer 11

FH
IgA deficency
Type 1 diabetes
Autoimmune thyroid disease

Question 12

What are some weak risk factors of Coeliac?

Answer 12

Down’s
Sjorgen’s
IBD
Primary biliary cholangitis

Question 13

What are the 1st line investigations to order in Coeliac disease?

Answer 13

FBC and blood smear

Immunoglobulin A-tissues transglutaminase (IgA-tTG)

Skin biopsy for dermatitis herpetiformis

Small bowel endoscopy

Small bowel histology

Question 14

What are you looking for on FBC in coeliac?

Answer 14

Iron deficiency anaemia
Macrocytic - folate deficiency
Low Hb
Microcytic and hypochromic red cells

Question 15

What might be seen on endoscopy in coeliac?

Answer 15

Atrophy and scalloping of mucosal folds

Nodularity and mosaic pattern of mucosa

Question 16

What is gold standard for diagnosis Coeliac?

Answer 16

Small bowel histology

Performed whilst on Gluten diet

Question 17

What would be seen on a positive biopsy for Coeliac?

Answer 17

Presence of intra-epithelial lymphocytes
Villous atrophy
Crypt hyperplasia

Question 18

What investigations should be considered in Coeliac?

Answer 18

HLA typing (human leukocyte antigen)

Gluten challenge

Video capsule endoscopy

Question 19

What is visual capsule endoscopy?

Answer 19

Imaging of the entire small intestine

Question 20

What is the first line treatment for Coeliac disease?

Answer 20

GF diet

Vitamin and mineral supplementation

Question 21

What is treatment for coeliac when a patient fails to respond to therapy?

Answer 21

Referral to dietician or gastroenterologist

Question 22

What do you do in a coeliac crisis?

Answer 22

Rehydration + correction of electrolyte abnormalities

adjunct - corticosteroid